Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Abstract

Purpose The aim of this study was to compare two methods of two-stage surgery for PJI (periprosthetic joint infection) after THA (total hip arthroplasty): one with and one without the use of an antibiotic-loaded cement spacer. Methods This retrospective study was performed on 99 consecutive patients (99 hips) with a minimum follow-up of 24 months. Patients were divided into two groups: (1) in whom the operation was performed using a spacer, and (2) for whom a spacer was not used. Results For the whole cohort, the results improved between pre-operative and final follow-up. Recurrence of infection was found in nine out of 98 patients (9.2%) and was not significantly different between the two groups. Patients treated with a spacer had better functional improvement in the interim period, but the VAS score was better in the non-spacer group. The improvement in final function was better in the spacer group with regard to HHS, but not according to WOMAC score or VAS at final follow-up. Conclusion The resection arthroplasty should be awarded particular consideration in cases of poor soft tissue quality, bone stock deficiency, when complications related to spacer use are expected or chances of new hip endoprosthesis implantation are low.

Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

“…Therefore, with similar leg length discrepancy rates and median discrepancies, two-stage revision involving resection arthroplasty with a short interval was comparable with two-stage revision using a PMMA bone cement spacer during the interval. Other authors described more pronounced leg shortening in case of delayed reimplantation [24]. If an early reconstruction after resection arthroplasty is performed, results were similar to those in whom a spacer was used [10].…”

“…The present study did not include an evaluation of functional outcome. However, in the retrospective study by Marczak et al, the final Harris hip score (HHS) and visual analogue scale (VAS) score showed no difference between patients treated with a two-stage revision with or without spacer, while the final WOMAC (Western Ontario and McMaster Universities osteoarthritis index) score showed a better outcome in the spacer group [24]. The decision to use a spacer in this study was based on the preferences of the surgeon and local bone deficiency.…”

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

“…The implantation of a temporary antibiotic-impregnated spacer in the interim period is used worldwide in two-stage exchange arthroplasty, since it enables preservation of the joint space, ensures high local concentrations of antibiotics, and the reimplantation sometimes can be easier due to the absence of scar tissue in the acetabulum and medullary canal [43]. Nevertheless, spacers may act as a foreign body to which microorganisms may adhere, grow, and maintain infection [44, 45].…”

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

“… 9 Marczak et al reported a significant difference in terms of functional improvement (according to the Harris hip score) between their spacer and a non-spacer cohort treated with two-stage replacement due to PJI. 24 The same authors reported an infection recurrence rate of 9.2% that was comparable in the two groups.…”